Placebo Phenomenon: Implications in Daily Clinical Practice

Investigating the role of the placebo effect in daily clinical practice, its impact on medical treatments, and its connection to spontaneous remission.
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Introduction

The placebo effect has long been a topic of interest and debate among medical professionals and researchers. While the phenomenon has been recognized for centuries, our understanding of it has evolved significantly in recent years. The term “placebo” is derived from the Latin word “placebo,” meaning “I shall please.” In medical research, a placebo is an inactive substance or treatment with no therapeutic effect used as a control in clinical trials to determine the effectiveness of a new drug or treatment. The placebo phenomenon refers to the fact that some patients who receive a placebo treatment experience improvements in their symptoms or even complete recovery simply because they believe they are receiving a legitimate medical treatment. This article delves into the newest research on the placebo phenomenon, exploring its role in daily clinical practice, its impact on medical treatments, and its connection to spontaneous remission.

Beyond Mere Suggestion: Understanding the Mechanisms Behind Placebo

Traditionally, the placebo effect was thought to result from suggestion, where patients’ symptoms improve or disappear because they believe the treatment is effective. However, recent research has shown that the placebo effect is more complex and extends beyond mere suggestion. The brain’s natural painkillers, endorphins, are thought to play a crucial role in the placebo effect. When a person experiences pain, their brain releases endorphins to help alleviate the pain. Some studies have found that when a person takes a placebo, their brain releases endorphins, just as it would if taking an actual painkiller (1).

One of the most influential scientists in the field of placebo research is Dr. Fabrizio Benedetti, a professor of neuroscience at the University of Turin in Italy. In his book, “Placebo Effects: Understanding the Mechanisms in Health and Disease,” Dr. Benedetti writes, “The placebo effect has evolved from being thought of as a nuisance in clinical pharmacological research to a biological phenomenon worthy of scientific investigation in its own right.” (2)

Dr. Benedetti’s work has been instrumental in uncovering the complex neurobiological mechanisms underlying the placebo effect. His research has shown that the placebo effect can be mediated by different neurotransmitters, such as endorphins, dopamine, and serotonin, depending on the treatment condition (3). This has led to a better understanding of how the placebo effect works and has highlighted the importance of considering the placebo effect in the design and interpretation of clinical trials.

Placebo in Daily Clinical Practice

The placebo phenomenon has significant implications for daily clinical practice. Sometimes, treatment can improve a patient’s condition regardless of its effectiveness. This has led some medical professionals to argue that the placebo effect should be harnessed as a therapeutic tool in clinical practice. For example, a study published in the New England Journal of Medicine found that patients with irritable bowel syndrome who received a placebo treatment experienced significant improvements in their symptoms compared to those who received no treatment at all (4). This suggests that the mere act of administering treatment can positively impact a patient’s well-being.

However, using placebos in clinical practice raises ethical concerns, as it involves deceiving patients about the nature of their treatment. Some argue that it is never moral to mislead patients. In contrast, others believe that the potential benefits of the placebo effect outweigh the ethical concerns, particularly in cases where no effective treatment is available. Furthermore, it is essential to recognize that the placebo effect is only sometimes beneficial, as it may work differently in different individuals and conditions (5).

There is also evidence to suggest that the effectiveness of specific medical treatments may be partially attributed to the placebo effect. For example, a study published in JAMA Internal Medicine found that patients who received a nonopioid painkiller experienced similar levels of pain relief as those who received an opioid analgesic, suggesting that the placebo effect may play a role in the perceived efficacy of these medications (6). This finding has implications for managing pain and the ongoing opioid crisis, highlighting the need better to understand the placebo effect and its potential therapeutic applications.

Spontaneous Remission and the Placebo Effect

Spontaneous remission refers to the unexpected improvement or complete recovery of a patient from a disease or condition without any medical intervention or despite medical treatment deemed unlikely to have caused the improvement. Spontaneous remission has been reported in various medical conditions, including cancer, autoimmune diseases, and infections (7).

Growing evidence suggests that the placebo effect may play a role in spontaneous remission. Some researchers have hypothesized that the psychological factors associated with the placebo effect, such as positive expectations and stress reduction, can trigger physiological changes that promote healing (8). For example, a study published in a “Cancer” journal found that patients with advanced cancer with high hope and optimism experienced longer survival times than those with lower hope and optimism (9).

Additionally, research has shown that the immune system plays a critical role in spontaneous remission. A study published in Nature Immunology found that the immune system can sometimes recognize and destroy cancer cells, leading to spontaneous remission (10). It has been suggested that the psychological factors associated with the placebo effect may influence the immune system, sometimes promoting spontaneous remission (11).

While the exact mechanisms underlying the connection between the placebo effect and spontaneous remission remain unclear, this area of research highlights the potential of harnessing the placebo effect to promote healing and improve patient outcomes.

Conclusion

The placebo phenomenon is a complex and fascinating area of research that has significant implications for daily clinical practice, medical treatments, and our understanding of spontaneous remission. As our knowledge of the placebo effect grows, it is increasingly evident that this phenomenon extends beyond mere suggestion and involves a range of neurobiological mechanisms. Harnessing the power of the placebo effect in clinical practice can improve patient outcomes but also raises ethical concerns.

Future research efforts should focus on better understanding the mechanisms underlying the placebo effect and identifying ways to ethically harness its power to benefit patients. Further investigation into the connection between the placebo effect and spontaneous remission may provide valuable insights into the body’s natural healing processes and pave the way for new therapeutic interventions.

References:

(1) Levine JD, Gordon NC, Fields HL. The Mechanism Of Placebo Analgesia. Lancet. 1978 Sep 23;2(8091):654-7.
(2) Benedetti, F. (2014). Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford University Press.
(3) Benedetti F, Amanzio M, Casadio C, Oliaro A, Maggi G. Blockade Of Nocebo Hyperalgesia By The Cholecystokinin Antagonist Proglumide. Pain. 1997 Jul;71(2):135-40.
(4) Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, Singer JP, Kowalczykowski M, Miller FG, Kirsch I, Lembo AJ. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One. 2010 Dec 22;5(12):e15591.
(5) Colloca L, Miller FG. The Nocebo Effect And Its Relevance For Clinical Practice. Psychosom Med. 2011 Sep;73(7):598-603.
(6) Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018 Mar 6;319(9):872-882.
(7) O’Regan B, Hirshberg C. Spontaneous Remission: An Annotated Bibliography. Institute of Noetic Sciences, 1993.
(8) Geers AL, Rose JP, Fowler SL, Rasinski HM, Brown JA, Helfer SG. Why does choice enhance treatment effectiveness? Using placebo treatments to demonstrate the role of personal control. J Pers Soc Psychol. 2013 Sep;105(3):549-66.
(9) Allison PJ, Guichard C, Fung K, Gilain L. Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients. J Clin Oncol. 2003 Feb 15;21(4):543-8.
(10) Dunn GP, Bruce AT, Ikeda H, Old LJ, Schreiber RD. Cancer immunoediting: from immunosurveillance to tumor escape. Nat Immunol. 2002 Nov;3(11):991-8.
(11) Andersen BL, Farrar WB, Golden-Kreutz D, Kutz LA, MacCallum R, Courtney ME, Glaser R. Stress and immune responses after surgical treatment for regional breast cancer. J Natl Cancer Inst. 1998 Jan 7;90(1):30-6.

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FAQ

FREQUENTLY ASKED QUESTIONS

by ivan roca

GENERAL

Bioqr™ is bioenergy-assisted immune treatment. A therapist uses his own bio-electromagnetic field to stimulate the patient’s immune system in a nonspecific and specific way. The stimulated immune system responds and “heals” the patient.

Bioqr™ therapy is a bioenergy treatment first developed in Eastern-Europe in the late 1960s as a modern, secular approach to traditional hands-on healing methods with biological and physical reasoning. Later, the method crossed Eastern-Europe to ex-Yugoslavia in the late 1970s’ where it has merged with similar methodologies and has been researched and applied as a complementary medical intervention. The founder of Biotherapy Asia, Ivan Roca, adapted these methodologies and cleared it from the folklore and unnecessary procedures, techniques, and philosophies. Bioqr™ method is a purely medical, highly structured bioenergy system that can be easily applied in a clinical or non-formal environment. The name of the method is Bioqr™ – Human Bioenergy Therapy.

Bioenergy is the energy dynamic observed within living organisms. Also, it is a scientific name that tries to encompass a very broad interdisciplinary area of research into the energy of a living organism. “Bios” is an Ancient Greek word meaning life, and energy is another Ancient Greek word, meaning activity, but here it signifies potential and possibility. Bioenergy has nothing to do with concepts like bioplasma, Chi, Qi, Ki, Prana, Universal energy, Life energy or Orgon.

Yes, with an electromyography device (EMG).

EMG is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyograph detects the electric potential generated by muscle cells when these cells are electrically or neurologically activated.

No. The therapy is successful even if a person does not believe in the biological effect of the immune system stimulation with the human bioenergy field, which is a result of ignorance and a lack of information.

The body response does not depend on our beliefs. It is an automatic and autonomic biological process.

A Bioqr™ therapist uses different hand positions and movements in combination with muscular tension and/or relaxation to stimulate the recipient’s immune system for his/her specific medical condition. Human endogenous bio-electromagnetic radiation interferes with the bioenergy processes of a diseased person to alter the metabolism and cause a body shock response that triggers the immune system activation in a specific and non-specific way.
Every movement has a different energetic signature so that the biotherapist can trigger an immune response in different tissues for different purposes. Immune response due to a “shock” to maintain homeostasis (check danger model of the immune system from Dr. Polly Matzinger), stimulates natural defenses.

A therapist uses muscular tension and relaxation to consciously send bioelectrical signaling (active potentials) of a higher or lower electromagnetic radiation intensity into the area of the hands. Propagation of the action potentials in the nerves and muscles produces a bio-electromagnetic field that radiates outside of the human body.

All the ‘manipulation’ processes occur automatically which is a completely natural process that is constantly taking place, but most of the time we are not aware of it. Bioenergy therapy is the application of natural energy processes and laws for awakening your own immune defenses, which due to a disharmonious way of life or due to some other factors (genetics, environment, etc.) become weakened or stop functioning entirely.

Learn HERE more.

Bioenergetics is the part of biochemistry concerned with the energy involved in making and breaking of chemical bonds in the molecules found in biological organisms. It can also be defined as the study of energy relationships and energy transformations and transductions in living organisms. The ability to harness energy from a variety of metabolic pathways is a property of all living organisms. Growth, development, anabolism, and catabolism are some of the central processes in the study of biological organisms because the role of energy is fundamental to such biological processes. Life is dependent on energy transformations; living organisms survive because of the exchange of energy between living tissues/ cells and the outside environment.

The essence of the biofield perspective is that a variety of endogenously generated electromagnetic and other fields act within and between multiple levels of biology, from molecular and cellular, through tissues and whole organisms to affect our personal and perhaps even our interpersonal functioning. The human body is a biofield.

Biofield science is an emerging field of study that aims to provide a scientific foundation for understanding the complex homeodynamic regulation of living systems. By furthering our scientific knowledge of the biofield, we arrive at a better understanding of the foundations of biology as well as the phenomena that have been described as “energy medicine.”
Biotherapy is biofield therapy.

Yes, bioenergy/energy therapy is nowadays practiced throughout the world and is called biofield therapy. New approaches in scientific research are slowly revealing the possible mechanism of bioenergy therapy. Many hospitals and medical centers are slowly starting to integrate bioenergy therapy to complement and support conventional medicine.

THERAPY

No, Bioqr™ therapy is complementary and supplementary to all other medical and ‘alternative’ therapies, even though, in many cases, it is much more successful and efficient. After therapy, you should not discontinue the medication or other treatments or medical procedures prescribed by your doctor. Only a biomedical check-up can confirm improvement and make further decisions in conjunction with the patient about continuing or discontinuing conventional medical treatment.

With groups of people, energy potentials multiply and “share” automatically. When in a group, it is easier to observe improvement during the therapy itself. It is also easier to exchange experiences. Group dynamics are an essential part of the subconscious work.

No! A natural energy process cannot be harmful in itself. Biotherapy is a noninvasive treatment without side-effects.

Yes, a diagnosis is necessary from a doctor. We do not diagnose.

No special preparation is needed. It is advisable to come at least 15 minutes before the beginning of therapy. It is desirable to free yourself from as many commitments as possible during the therapy days. Strong reactions during therapy are possible which can interfere with our everyday activities. It can be detrimental to the therapy if we are forced to rush off somewhere, or if we are not totally committed to the therapeutic process. Therapy cannot be beneficial if we are feeling pressured.

Depending on the individual, what is felt ranges from very powerful sensations to no sensation at all. Some people feel a tingling, burning or prickling sensation, coldness, draft, pressure, momentary relief, fatigue or drowsiness, uncontrollable laughter or crying, a floating sensation in the extremities, body movement, dizziness or vertigo. Whether or not a patient feels something during therapy, is not an indication of the success of the therapy, because everybody is unique and therefore they react in unique ways.

No, only a medical specialist can decide about discontinuing the medication. 

After 15 to 30 days, depending on the condition treated, one can expect results that can be objectively measured by means of clinical medicine. Sometimes in the first 15 days after therapy symptoms increase, or a sudden deterioration occurs, which is a crisis that signifies a strong bodily reaction to the intensified activities of a regenerated immune system.

Therapy can be repeated in consultation with a therapist and in accordance with other therapeutic forms that are applied.

Yes, but it is important for the patient to personally commit to the decision to stop drug or alcohol misuse.

All diseases can be treated successfully. With some diseases, the objective success will be complete recovery, while with others, symptoms of the disease will be alleviated, or the result will be greater independence for the patient or arrest the development of the disease, depending on a number of factors that are not directly related to Bioqr™ therapy. We don’t treat medical conditions with psychosis or contagious diseases.

Yes, except schizophrenia and other mental diseases with psychosis. Patients with mental diseases must be accompanied.

With genetic diseases, we can only maintain symptoms with treatments on a monthly or a bi-monthly basis.

Yes, children of any age can be treated.

Yes. If the patient is vulnerable or being cared for by somebody else, then they will need to be accompanied.

Yes, it is possible for educational or research purposes and if you accompany someone else for some objective medical reason.

There is no price enforced for the therapy. At the end of the therapy session, an anonymous donation is made to the therapist.

MISCONCEPTIONS

Bioqr™ therapy is not based around the traditional concepts of the Life Force or Life energy like Qi or Prana. These concepts belong to Vitalism which was dropped in biology almost 100 years ago. Traditional concepts of the Life Force don’t have any scientific evidence to support its existence. Also, modern biophysics, biology, biochemistry, bioinformatics, and genetics operate in a realm of the modern understanding of the world which is evidence-based knowledge. Qi, Prana, Pneuma and Life Force are spiritual concepts that are not biological or physical. The etymology of the words Qi, Prana, and Spirit is the same, the breath. 

No, we are based on a very modern approach to bioenergy therapy. Chakras and Auras don’t exist in a biological realm. They are only interesting mental concepts developed as a part of the New Age movement. To put it in a simple way, there is no Chakra and Aura as physical entities. They are just concepts.

Nothing in the classical sense where the healer is considered to be more spiritual than others. Medicine is a science of the mind, body and social well-being. Spirituality is a concept of the world that has many different faces and understandings. Medicine and spirituality are two completely different subjects. In some special cases, spiritual thinking can be beneficial for the patients, for example in hospice, pain management, palliative care, psychological work, etc.

No, this is a misconception that has roots in spiritism and animism. Energy is not bad or good. Energy is benevolent. Sometimes people use the word “energy” to express emotional states which are purely subjective and have nothing to do with term energy in modern physics.

Nothing, it is another misconception where a few psychological phenomena were thought to be the sixth sense. Unfortunately, humans don’t have magneto-receptors and electro-receptors beyond 5 senses which are developed due to our evolutionary needs to protect and survive.

No, anyone can do energy therapy. Healing is not a supernatural ‘special power’ that somebody possesses, but an application of knowledge and skills.